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Background:  Endoscopic submucosal dissection (ESD) is associated with a risk of bleeding. Bleeding is usually treated with diathermy, although this does carry a risk of mucosal thermal injury. Purastat is a topical hemostat that may be effective in controlling bleeding during ESD, thereby reducing the use of heat therapy. The aim of this study was to assess the reduction in heat therapy used in the interventional group (Purastat) compared with the control group. The secondary aims were to compare the procedure length, time for hemostasis, delayed bleeding rate, adverse events, and wound healing between the groups.Methods:  This was a single-center randomized controlled trial of 101 patients undergoing ESD. Participants were randomized to a control group where diathermy was used to control bleeding or an interventional group where Purastat could be used. Follow-up endoscopy was performed at 4 weeks to assess wound healing.Results:  There was a significant reduction in the use of heat therapy for intraprocedural hemostasis in the interventional group compared with controls (49.3 % vs. 99.6 %, P < 0.001). There were no significant differences in the procedure length, time for hemostasis, and delayed bleeding rate between the groups. Complete wound healing at 4 weeks was noted in 48.8 % of patients in the interventional group compared with 25.0 % of controls (P = 0.02).Conclusions:  This study has demonstrated that Purastat is an effective hemostat that can reduce the need for heat therapy for bleeding during ESD. It may also have a role in improving post-resection wound healing. [ABSTRACT FROM AUTHOR]

Objectives Out-of-pocket (OOP) payment for modern contraception is an understudied component of healthcare financing in countries like Kenya, where wealth gradients in met need have prompted efforts to expand access to free contraception. This study aims to examine whether, among public sector providers, the poor are more likely to receive free contraception and to compare how OOP payment for injectables and implants-two popular methods-differs by public/private provider type and user's sociodemographic characteristics. Design, setting and participants Secondary analyses of nationally representative, cross-sectional household data from the 2014 Kenya Demographic and Health Survey. Respondents were women of reproductive age (15-49 years). The sample comprised 5717 current modern contraception users, including 2691 injectable and 1073 implant users with non-missing expenditure values. Main outcome Respondent's self-reported source and payment to obtain their current modern contraceptive method. Methods We used multivariable logistic regression to examine predictors of free public sector contraception and compared average expenditure for injectable and implant. Quintile ratios examined progressivity of non-zero expenditure by wealth. Results Half of public sector users reported free contraception; this varied considerably by method and region. Users of implants, condoms, pills and intrauterine devices were all more likely to report receiving their method for free (p<0.001) compared with injectable users. The poorest were as likely to pay for contraception as the wealthiest users at public providers (OR: 1.10, 95% CI: 0.64 to 1.91). Across all providers, among users with nonzero expenditure, injectable and implant users reported a mean OOP payment of Kenyan shillings (KES) 80 (US$0.91), 95% CI: KES 78 to 82 and KES 378 (US$4.31), 95% CI: KES 327 to 429, respectively. In the public sector, expenditure was pro-poor for injectable users yet weakly pro-rich for implant users. Conclusions More attention is needed to targeting subsidies to the poorest and ensuring government facilities are equipped to cope with lost user fee revenue. [ABSTRACT FROM AUTHOR]

Economic conditions have dramatic influences on fertility. This paper evaluates the effect of the 2008 ‘Great Recession’ in the UK on first birth rate, which is the fertility behaviour most susceptible to external economic conditions. The key aim of the study was to assess the effect of the recession on fertility by individual-level characteristics, enabling variation in responses to economic hardship to be observed. Data were from the nationally representative UK Household Longitudinal Study (UK-HLS). Cumulative transition models were used to model the probability of first birth for women between the ages of 17 and 30 in three UK birth cohorts. The effect of the recession was captured using direct measures (local unemployment rates and individual unemployment status) and a pre-/post-comparison, capturing indirect effects. In general, higher birth rates were observed among more disadvantaged women compared with advantaged groups. The effect of the recession was disaggregated by social strata; the overall effect was counter-cyclical although at a slower rate among disadvantaged women. [ABSTRACT FROM PUBLISHER]

This study examines the role of structural and agentic resources in shaping school-to-work transitions in England. We ask to what extent are young people able to steer the course of their lives despite the constraining forces of social structure, and how satisfied are they with their lives following the completion of compulsory schooling. Drawing on data from the Longitudinal Study of Young People in England we use sequence analysis of monthly activity data to identify differences in the timing and sequencing of education and employment transitions. We identified six distinct pathways, differentiating between an academic track, three pathways involving further education and training, as well as a work-focused transition and a group of young people who were over a long period not in education or training (NEET). The findings suggest that not all young people are inclined to follow an academic track and instead select into pathways involving vocational training or further education, enabling them to experience competence and life satisfaction. For others (about one in 10), however, the lack of socioeconomic and psycho-social resources is too overwhelming and they encounter long-term experience of NEET or are not able to transform their educational credentials into employment opportunities. The findings highlight that in addition to considering structural constraints it is important to conceptualise the role of the agent for a better understanding of variations in youth transitions. [ABSTRACT FROM AUTHOR]

Objectives: To test the contraceptive confidence hypothesis in a modern context. The hypothesis is that women using effective or modern contraceptive methods have increased contraceptive confidence and hence a shorter interval between marriage and first birth than users of ineffective or traditional methods. We extend the hypothesis to incorporate the role of abortion, arguing that it acts as a substitute for contraception in the study context. Setting: Moldova, a country in South-East Europe. Moldova exhibits high use of traditional contraceptive methods and abortion compared with other European countries. Participants: Data are from a secondary analysis of the 2005 Moldovan Demographic and Health Survey, a nationally representative sample survey. 5377 unmarried women were selected. Primary and secondary outcome measures: The outcome measure was the interval between marriage and first birth. This was modelled using a piecewise-constant hazard regression, with abortion and contraceptive method types as primary variables along with relevant sociodemographic controls. Results: Women with high contraceptive confidence (modern method users) have a higher cumulative hazard of first birth 36 months following marriage (0.88 (0.87 to 0.89)) compared with women with low contraceptive confidence (traditional method users, cumulative hazard: 0.85 (0.84 to 0.85)). This is consistent with the contraceptive confidence hypothesis. There is a higher cumulative hazard of first birth among women with low (0.80 (0.79 to 0.80)) and moderate abortion propensities (0.76 (0.75 to 0.77)) than women with no abortion propensity (0.73 (0.72 to 0.74)) 24 months after marriage. Conclusions: Effective contraceptive use tends to increase contraceptive confidence and is associated with a shorter interval between marriage and first birth. Increased use of abortion also tends to increase contraceptive confidence and shorten birth duration, although this effect is non-linear--women with a very high use of abortion tend to have lengthy intervals between marriage and first birth. [ABSTRACT FROM AUTHOR]